Provider Demographics
NPI:1649895194
Name:GRASS VALLEY RADIATION ONCOLOGY
Entity type:Organization
Organization Name:GRASS VALLEY RADIATION ONCOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CLAYTON
Authorized Official - Middle Name:B
Authorized Official - Last Name:HESS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-733-5626
Mailing Address - Street 1:PO BOX 24132
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-0132
Mailing Address - Country:US
Mailing Address - Phone:800-329-1906
Mailing Address - Fax:407-682-4844
Practice Address - Street 1:155 GLASSON WAY BLDG 3L-20
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-5723
Practice Address - Country:US
Practice Address - Phone:407-788-1906
Practice Address - Fax:407-682-4844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-10
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty